Sammanfattning
Introduction: The aim was to determine the incidence of anal incontinence, recurrence rate and patient satisfaction after using slow-cutting setons for transsphincteric anal fistula repair. Material and methods: A retrospective study with prospective follow up in 58 patients who had undergone surgery for transspincteric perianal fistulas with a slow-cutting seton. A total of 17 patients were excluded or lost in the follow up period. A questionnaire was send to 41 cases to the severity of incontinence for gas, liquid and stool according to the Wexner-score. Recurrence rate, sick leave and satisfaction with the treatment were estimated. Results: The questionnaire was returned from 34 patients. In all 23 men and 11 women had the seton tightened for the first time after a mean period of 32 days. The mean number of tightenings was five (range: 2-9). The mean duration of treatment was 256 days (range: 61-634). A total of four patients (12%) experienced recurrence. Twenty-one patients (61,7%) had a Wexner score of one or more. Eight patients (23,5%) scored more than four. A total of 28 patients (82%) were 75-100% satisfied with the treatment. Two patients (6%) were absolutely dissatisfied, and were considered failures. We found no association between the reported satisfaction with the treatment and the degree of incontinence. Conclusion: Despite a very high level of satisfaction among the patients, the high rate of incontinence suggests that other non-invasive techniques should be used as first-line treatment of anal fistulas. In cases where multiple attempts at repair have failed, the slow-cutting seton may be the best option.